Bridging the integration gap between patient-generated blood glucose data and electronic health records

Telemedicine can facilitate population health management by extending the reach of providers to efficiently care for high-risk, high-utilization populations. However, for telemedicine to be maximally useful, data collected using telemedicine technologies must be reliable and readily available to healthcare providers. To address current gaps in integration of patient-generated health data into the electronic health record (EHR), we examined 2 patient-facing platforms, Epic MyChart and Apple HealthKit, both of which facilitated the uploading of blood glucose data into the EHR as part of a diabetes telemedicine intervention. All patients were offered use of the MyChart platform; we subsequently invited a purposive sample of patients who used the MyChart platform effectively (n = 5) to also use the Apple HealthKit platform. Patients reported both platforms helped with diabetes self-management, and providers appreciated the convenience of the processes for obtaining patient data. Providers stated that the EHR data presentation format for Apple HealthKit was challenging to interpret; however, they also valued the greater perceived accuracy the Apple HealthKit data. Our findings indicate that patient-facing platforms can feasibly facilitate transmission of patient-generated health data into the EHR and support telemedicine-based care.

[1]  S. Burwell,et al.  Setting value-based payment goals--HHS efforts to improve U.S. health care. , 2015, The New England journal of medicine.

[2]  J. WakefieldBonnie,et al.  Effect of home telemonitoring on glycemic and blood pressure control in primary care clinic patients with diabetes. , 2014 .

[3]  Hsiu-Fang Hsieh,et al.  Three Approaches to Qualitative Content Analysis , 2005, Qualitative health research.

[4]  D. Klonoff Using Telemedicine to Improve Outcomes in Diabetes—An Emerging Technology , 2009, Journal of diabetes science and technology.

[5]  J. Kvedar,et al.  Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. , 2014, Health affairs.

[6]  Matthew J Crowley,et al.  Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial. , 2016, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[7]  N. Heintzman A Digital Ecosystem of Diabetes Data and Technology , 2016, Journal of diabetes science and technology.

[8]  Jacqueline Merrill,et al.  Converging and diverging needs between patients and providers who are collecting and using patient-generated health data: an integrative review , 2018, J. Am. Medical Informatics Assoc..

[9]  Gillian R. Hayes,et al.  Integrating Patient-Generated Health Data Into Clinical Care Settings or Clinical Decision-Making: Lessons Learned From Project HealthDesign , 2016, JMIR human factors.

[10]  R. Chaudhry,et al.  Apple HealthKit and Health App: Patient Uptake and Barriers in Primary Care. , 2016, Telemedicine journal and e-health.

[11]  M. Turakhia,et al.  Using Digital Health Technology to Better Generate Evidence and Deliver Evidence-Based Care. , 2018, Journal of the American College of Cardiology.

[12]  N. Lv,et al.  Personalized Hypertension Management Using Patient-Generated Health Data Integrated With Electronic Health Records (EMPOWER-H): Six-Month Pre-Post Study , 2017, Journal of medical Internet research.

[13]  Bonnie J Wakefield,et al.  Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[14]  Nathorn Chaiyakunapruk,et al.  Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis , 2017, Scientific Reports.

[15]  M. Tonelli,et al.  Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials , 2016, Canadian Medical Association Journal.

[16]  A. Farmer,et al.  Interactive telemedicine: effects on professional practice and health care outcomes. , 2015, The Cochrane database of systematic reviews.

[17]  Dennis P. Wall,et al.  Automated integration of continuous glucose monitor data in the electronic health record using consumer technology , 2016, J. Am. Medical Informatics Assoc..

[18]  R. Jacobson,et al.  Population Health as a Means for Health Care Organizations to Deliver Value. , 2015, Mayo Clinic proceedings.